tbuckley/cabot-search huggingface dataset:
Longitudinal assessment of material financial hardship and food insecurity among families of Hispanic/Latino and non-Hispanic/Latino White childhood patients with cancer.
Authors: Matthew P. Banegas, Paula Aristizabal, Corinne McDaniels-Davidson, Jesse Nodora
Journal: Journal of Clinical Oncology (2022)

276 Background: Cancer is the second leading cause of death among US children. Among Hispanic/Latino (H/L) childhood cancer patients, social, economic, and cultural barriers increase risk for limited access to cancer care and poor health outcomes. We compared the prevalence of material financial hardship (MFH) and food insecurity over time between H/L and non-H/L White families of childhood cancer patients. We hypothesized H/L families would have higher MFH and food insecurity. Methods: In this prospective observational study, parents/guardians (n = 107) of children with newly diagnosed cancer and receiving treatment at Rady Children’s Hospital San Diego were enrolled from July 2019 to November 2021. Eligible participants included primary caregivers of a child aged 0-17 years who was newly diagnosis with cancer and who were able to write and speak English or Spanish. The primary outcomes of MFH and food insecurity were collected via survey at baseline, 3-, 6-, 12- and 24-months following enrollment. Sociodemographic and clinical characteristics were collected at baseline only. Separate generalized estimating equation models with binomial distribution and exchangeable correlation structure were used to assess the longitudinal associations between H/L ethnicity with MFH and food insecurity, adjusting for sociodemographic covariates. Results: Study participants included 61 H/L (57%) and 46 non-H/L White (43%) parents/guardians. The majority were married (74%), &lt; 45 years old (80%), primarily spoke English at home (74%) and had public insurance (55%). At baseline, MFH was reported by 63% of H/Ls and 38% of non-H/L Whites, while food insecurity was reported by 56% of H/Ls and 44% of non-H/L Whites. In adjusted GEE models, H/Ls experienced a lower, though non-significant, risk of both MFH (adjusted Odds Ratio [ORadj] = 0.85, 95% Confidence Interval [95% CI]:0.39-1.87] and food insecurity (ORadj = 0.58, 95% CI:0.22-1.55) over time, compared to non-H/L Whites. Public insurance was associated with increased risk of MFH (ORadj = 2.71, 95% CI:1.23-5.96] and food insecurity (ORadj = 4.09, 95% CI:1.39, 12.05) over time, compared to private insurance. Conclusions: In this prospective study, self-reported MFH and food security were highly prevalent in the 24 months following baseline, though they did not significantly differ between H/L and non-H/L White parents/caregivers. Public insurance was associated with excess risk of both MFH and food insecurity, over time. Despite no observed differences, it is imperative that larger, prospective studies investigate the long-term patterns of social risks among underserved and underrepresented families of childhood cancer patients, as well as the association between social risk and cancer outcomes.
Is patient experience of care associated with treatment choices for women with early-stage breast cancer?
Authors: Michael T. Halpern, Timothy S. McNeel, David E. Kozono, Michelle Mollica
Journal: Journal of Clinical Oncology (2022)

289 Background: For women diagnosed with early stage breast cancer, lumpectomy followed by radiation therapy is a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment regimen for certain women. It is unclear what patient-driven factors are related to the decision to receive radiation therapy. This study examined the relationship between patient-reported experience of care, an important dimension of health care quality, and receipt of radiation therapy following lumpectomy among women with breast cancer. Methods: We used the SEER-CAHPS data resource (NCI Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses) to examine experiences of care among women diagnosed with local or regional stage breast cancer in 2000-2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey within 18 months of diagnosis, and survived for this study period. Experience of care was assessed by patient-provided numeric scores for overall care, health plan, physicians, customer service, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of radiation therapy with care experience and patient sociodemographic and clinical characteristics. Results: The study population included 825 women; 651 (79%) received radiation therapy. Approx. 84% were diagnosed with localized (vs. regional) breast cancer. Women with higher experience scores for their personal doctor or for care coordination were significantly more likely to have received any radiation therapy. In contrast, among women enrolled in Medicare Part D plans, those who reported higher scores for their prescription drug plan were significantly less likely to have received radiation therapy. Conclusions: Patient experience of care was significantly associated with receipt of radiation therapy following lumpectomy among women with breast cancer. While these results do not show causality, future quality improvement initiatives may want to explore the role of patient experience of care in facilitating patient decision making and improving quality of care.
Understanding adult survivors of childhood cancers: An analysis of a survivorship transitions clinic.
Authors: Stijn Hentzen, Kyla Alsman, Alicia O'Neal, Taylor Adams, Elizabeth Calhoun, Becky N. Lowry
Journal: Journal of Clinical Oncology (2022)

227 Background: As the prevalence of patients with cancer increases and improvements to treatment continue, the population of childhood cancer survivors (CCS) will see remarkable growth in coming years. Care for CCS requires collaboration between oncologists and primary care practitioners (PCPs). Long term follow up calls for unique attention to survivorship guidelines, the late effects of treatment, and the risk of secondary malignancies. To meet these needs, the cancer center at the University of Kansas Health System partnered with internal medicine to establish a primary care based STC. This study aimed to describe and analyze the population of cancer survivors in this clinic. Methods: After obtaining IRB approval, a retrospective chart review was completed for patients established in the STC between 2014 and 2022. Subjects were de-identified and analysis was performed using Microsoft Excel. Results: The 261 patients were 57% (150) female and had an average age of 12 (2 months - 41 years) at the time of cancer diagnosis and an average age of 28 (18 – 61 years) at the time of of clinic establishment. Patients were from 9 states, 47 counties, and 139 unique zipcodes. We identified 42 different cancers among the patients with ALL (24.5%) and Hodgkin’s Lymphoma (19.2%) most common. We found that 244 (93.5%) received chemotherapy, 138 (52.9%) received radiation, and 41 (15.7%) underwent bone marrow transplant. Secondary cancers were diagnosed in 30 (11.5%) of the patients with breast (23.3%) and thyroid (23.3%) malignancies most common. Three of these patients had two secondary malignancies. Conclusions: Our CCS population was clinically diverse in malignancy and treatment regimen. Nearly half of the patients received therapy in combination, adding to the complexity of late effects risks and care monitoring. This is emphasized by the prevalence of secondary malignancies which enforces the need for close follow up and adherence to survivorship guidelines. We found that despite the young age of cancer diagnosis, many of the patients established care in our clinic well into adulthood which is concerning for a gap in survivorship care as patients transition from treatment to follow up. Finally, the wide catchment area of this clinic is unique and shows the success of rural survivorship care at a tertiary medical center.
The concerning disaggregation of gender disparity and racial disparity investigation at recent ASCO annual meetings.
Authors: Ulysses Grant Gardner, Shearwood McClelland
Journal: Journal of Clinical Oncology (2022)

164 Background: There has been a recent emphasis in the peer-reviewed oncology literature on examining disparities by gender. Such emphasis provides an excellent opportunity to provide parallel disparities analysis. The degree to which gender disparities research has been performed concomitantly with racial disparities research at prominent oncologic societies has yet to be investigated. Methods: Abstracts presented at the American Society of Clinical Oncology (ASCO) annual meeting, the largest worldwide clinical oncology conference, were reviewed. Highly-valued abstracts selected for the elite oral abstract or clinical science symposium sessions at the 2020, 2021, and 2022 annual meetings were stratified to determine the amount of gender disparities research presented. Such research was then further assessed to determine whether racial disparities were examined simultaneously. Results: From 2020-2022, a total of 1,217 abstracts were presented at the ASCO annual meetings oral abstract or clinical science symposium sessions. Of these, seven involved gender disparities examination, of which only two (29%) concomitantly examined race. No study since 2020 concomitantly examined gender and racial disparities. Conclusions: More than 70% of elite gender disparities work presented at ASCO has been disaggregated from concomitant racial disparities examination, with complete disaggregation since 2021. Gender disparities work remains a miniscule aspect of the overall elite research landscape. Future work in examining gender disparities may be best aggregated with racial disparities in order to optimize timely solutions in both areas; such work could potentially be incentivized by stipulations of future funding mechanisms.
Prevalence of social risks among oncology patients in an integrated health care delivery system.
Authors: Deepika Kumar, Constanza Zamani, Ernesto Martin, Tatjana Kolevska, Jessica Payne, Tammy Rene Sheehan, Nancy P. Gordon, Olga Egorova, Candyce Kroenke, Elad Neeman, Raymond Liu
Journal: Journal of Clinical Oncology (2022)

128 Background: Social risks and needs can affect oncology treatment and outcomes, and some may be amenable to intervention before or during treatment. We surveyed Kaiser Permanente Northern California (KPNC) oncology patients to estimate prevalence of social risks among cancer patients. Methods: Adults undergoing treatment at KPNC infusion centers between 11/2021 – 05/2022 completed a print questionnaire that included questions about recent (past 3 month) financial strains, living, relationship, and transportation situation, and different aspects of social support. Results: A total of 767 patients completed surveys in English. Respondents were 63% female, median age 63y, and majority White (61% White, 19% Asian, 11% Latino, 7% Black) and college-educated (28% some college, 45% ≥ bachelor’s degree). About 20% lived alone, 35% were not in a committed relationship, 13% reported they did not usually get the social or emotional support they needed, and 3% often felt lonely or socially isolated. Approximately 24% said they had no one to help them with daily activities (shopping, cooking, transportation, etc.), 8% reported need for more help with daily activities, and 8% indicated that lack of transportation made it hard to get to medical appointments. Patients with no one to help them were more likely to indicate needing more help (14% vs. 6%). Additionally, while undergoing treatment, 6% were also acting as a primary caregiver to someone who was frail, chronically ill, or had a disability. Approximately 18% had experienced at last one recent financial strain, including trouble paying for medical/dental needs (9%), debts (8%), utilities (6%), food (5%), housing (3%), phone/internet (3%), or transportation (2%). Conclusions: Many patients lack adequate emotional and instrumental social support and may also be experiencing difficulties paying for recommended or essential medical and dental needs while undergoing cancer treatment. These findings highlight the importance of incorporating social risk screening into the oncology intake process so that this information is available to the oncology team for care planning and referral to institutional and community resources. In this way, the oncology care team may be able to improve social support and reduce financial and other barriers that may impact patient participation in treatment and treatment outcomes.
Discordance between patient with cancer and caregiving partner self-reported financial toxicity.
Authors: Zachary Rivers, Veena Shankaran, Laura S Porter, Shelby Langer
Journal: Journal of Clinical Oncology (2022)

182 Background: While financial toxicity (FT) is a well-documented problem facing cancer patients, few studies have simultaneously investigated the financial experiences of patients and their caregiving partners. Here, we report concordance and discordance in experiences of FT between cancer patients and their caregiving partners. Methods: Patients aged ≥18 with stage II-IV breast, lung, or colorectal cancer who had received treatment within the past two years and were married or in a committed, cohabitating relationship were enrolled along with their partners. Patient and caregiver responses to the FACIT-COST (lower scores indicating higher FT; score ≤ 26 meeting FT threshold) were calculated, and dyads were categorized as concordant or discordant in their experience of FT. Logistic regression models were used to explore patient and caregiver predictors of FT. Results: A total of 327 dyads (median patient age 53, 45% stage IV, 36% breast, 44% colorectal, 19% lung) were included in the analysis. Numeric COST scores were lower in patients (27, IQR: 19, 25) than in caregivers (30, IQR: 23,37) and more patients than caregivers met the threshold for FT (45% vs. 34%, p = 0.002). Both members of the dyad had similar FT experiences in 74% of cases (26% and 48% reported FT and no FT respectively) while 26% diverged in their experience of FT (8% of partners reported FT while the patient did not; 18% of patients reported FT while the caregiver did not.) Higher patient age was associated with a reduced odds of patient-reported FT (OR for each year: 0.92, 95% CI 0.86-0.98) while higher odds of FT was seen with increased patient comorbidities (OR: 1.56, 95% CI: 1.26-1.96 for each comorbidity) and patient race (Black OR: 1.41 - &gt; 10 compared to White). Similarly, caregiver comorbidity, caregiver race, and female sex increased the odds of caregiver-reported FT. In addition, the odds of caregiver-reported FT were higher with lower annual household income ($60,000-$120,000: OR: 0.26, 95% CI: 0.09-0.73, &gt; $120,000: OR 0.15, 95% CI 0.04-0.51 compared to less than $60,000), and the presence of children in the home (OR: 4.15, 95% CI: 1.88-9.67). Conclusions: More than a quarter of patients and caregivers had discordant experiences of FT. Assessing both members of a patient-caregiver dyad for FT is therefore critical to understanding the household financial impact of cancer diagnosis and treatment.
Oncologist perspectives on tumor boards: Virtual meetings and EHR integration.
Authors: Waddah Arafat, Paul Fu, Andrew J. Wagner, Travis Osterman, Daniel Martin, Jessica Sugalski, Tricia Heinrichs, Jennifer M. Racz, Amye Juliet Tevaarwerk
Journal: Journal of Clinical Oncology (2022)

46 Background: Tumor boards (TBs) are considered a key component for ensuring high quality cancer care. However, little is known about TB operational aspects that impact effectiveness. We aimed to understand how TBs leverage Electronic Health Record (EHR) functionalities and how pandemic-driven transitions from in-person TBs to virtual TBs impacted TB quality and effectiveness. Methods: The National Comprehensive Cancer Network (NCCN) Oncology EHR Advisory Group formed a Workgroup to assess the current state of TBs, obtain providers’ views on ideal TB state, and develop recommendations for improving TB quality and effectiveness. The Workgroup surveyed providers in various specialties at 31 NCCN Member Institutions in March 2022. Results: 846 providers from 27 institutions responded to the survey (n = 76 respondents were excluded from analysis because they reported not participating in TBs). Almost all (n = 764/767, 99%) indicated that one or more participants always or frequently attended TB meetings virtually. When comparing (newly established) virtual to (pre-pandemic) in-person TBs, 69% indicated increased attendance at virtual TBs. 65% reported no change in case volume, and 56% reported unchanged discussion quality while 19% reported increased discussion quality when comparing virtual to in-person TB meetings. In regards to EHR integration, several gaps between current and ideal state were noted. For instance, 40% always or frequently added patients to the TB roster via the EHR, but 57% reported this functionality to be very important or important for TBs. Additionally, 53% always or frequently document TB recommendations within the EHR, while 87% indicated EHR documentation of recommendations as very important or important. Respondents reported that barriers to documentation include resource constraints, concerns with patient access to documentation, legal and liability concerns, and poor EHR functionality. Conclusions: Overall, the majority of responding providers reported virtual TBs to be at least similar in quality to in-person TB meetings. A major gap identified by this study is the lack of documentation of TB recommendations in the EHR. Workflows and EHR functionalities could be improved to fully optimize the EHR for TB management and documentation.[Table: see text]
Electronic Frailty Index: A risk stratification tool for survival and health care outcomes in veterans with colorectal cancer.
Authors: Huili Zhu, Javad Razjouyan, Sudha Yarlagadda, Aanand Naik, Yvonne H Sada
Journal: Journal of Clinical Oncology (2022)

375 Background: Frailty reflects decreased physiologic reserve and subsequent increased vulnerability to stress. Frailty has been associated with poor health outcomes in patients with cancer, however traditional frailty indices are time consuming and not widely implemented in clinical oncology practice. An electronic frailty index (EFI) derived from electronic medical records (EMR) is an objective and standardized approach to frailty that can be automated. Little is known about the association between EFI and survival and healthcare utilization outcomes in patients with colorectal cancer (CRC). Methods: We used VA administrative files from 2016 – 2020 and the VA Central Cancer Registry to identify a cohort of patients diagnosed with CRC. EFI was calculated based on the Veterans Affairs-FI (VA-FI), a validated 31-item cumulative deficit FI, to define three groups: robust (≤0.1), prefrail (0.1-0.2), and frail (&gt; 0.2). We conducted Cox proportional hazard analyses to evaluate survival. We performed logistic regression to examine prolonged length of stay (LOS) ≥ median (11 days) during all-cause hospitalization and emergency department (ED) visits within one year after diagnosis. All models were adjusted for age, gender, race, Charlson comorbidity index, and stage. Confidence intervals (CI) were calculated as 95%. Results: Of 6,043 CRC patients (age: 69.7 ± 10.6 years), 45.6% were robust, 34.5% were prefrail, and 19.9% were frail. The cohort included 22.9% rectal cancer and 77.1% colon cancer cases, distributed across stages I (29.2%), II (25.0%), III (25.2%), and IV (20.6%). Increased risk of death was found in prefrail (adjusted hazard ratio [aHR] 1.21; CI 1.10-1.32) and frail (aHR 1.90; CI 1.71-2.11) patients when compared to robust patients. Increased odds of one-year ED visits were identified in prefrail (adjusted odds ratio [aOR] 1.18; CI 1.06 – 1.35) and frail (aOR, 1.66, CI 1.43-1.94) patients. Frailty status was associated with increased odds of one-year hospitalization of prolonged LOS among prefrail (aOR 1.38; CI 1.11-1.70) and frail patients (aOR 1.79; 95% CI 1.39-2.30). Conclusions: EFI was significantly associated with survival and healthcare utilization among patients with CRC, independent of stage. Frail patients had nearly 80% increased likelihood of prolonged hospitalization. EFI has the potential to be an automated and objective decision support tool at the point of care for risk assessment prior to CRC treatment-related stressors, such as surgery or chemotherapy. Future work is needed to develop a cancer specific EFI with dynamic variables that can be followed prospectively, as well as evaluating barriers to implementation within the EMR to guide treatment decisions and improve the quality of cancer care.
Disparities in place of death from prostate cancer revealed by disaggregation of Asian race.
Authors: Alexandra Noveihed, Naveena Lall, S. M. Qasim Hussaini, Pei-Lun Kuo, Amanda L. Blackford, Arjun Gupta, Ramy Sedhom
Journal: Journal of Clinical Oncology (2022)

187 Background: Place of death (PoD) is a surrogate determinant of health care inequity in patients with cancer. Aggregation of Asian Americans, a diverse group, may mask significant health disparities in end-of-life care. Methods: De-identified death certificate data were obtained via the National Center for Health Statistics. All adult (&gt; 18 years of age) prostate cancer deaths from 2018 to 2019 were included. Multinomial logistic regression was used to test for differences in place of death associated with sociodemographic variables. Results: From 2018 through 2019, 81,292 adults died from prostate cancer. Overall, most Asians were less likely to die at home (p &lt; 0.05) or nursing facility (p &lt; 0.05) compared to White patients. Significant differences in nursing facility use was noted in disaggregated analysis, with Samoan patients 12.44 times more likely to die in a hospice facility compared to hospital (CI 2.89, 53.6; p &lt; 0.001) and Chinese patients 100 times less likely to die in a hospice facility (CI 0.01, 0.02; p &lt; 0.001) to give two notable examples. Chinese (OR 0.26), Guamanian (OR 0.2), and Vietnamese race (OR 0.05) had the lowest likelihood of dying at home, with odds ratio lower than Black race (OR 0.3) (Table). Conclusions: Increased attention to PoD over recent years has highlighted issues around equity in end-of-life care. Overall, our data underscore important differences among Asian subpopulations and possible barriers to quality end of life care that would otherwise be masked with data aggregation. It is well known that resources are needed to allow death at home or at a nursing facility. Further qualitative work is planned to investigate culture differences contributing to PoD differences for patients with cancer through the lens of the social determinants of health.